Adversity, Toxic Stress & Resiliency. Baystate Medical Center:Family Advocacy Center Jessica Wozniak, Psy.D., Clinical Grants Coordinator

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1 Adversity, Toxic Stress & Resiliency Baystate Medical Center:Family Advocacy Center Jessica Wozniak, Psy.D., Clinical Grants Coordinator

2 Adverse Childhood Experiences ACE Study (www.acestudy.org) 18,000 participants w/kaiser Permanente Completed questionnaire and monitored for long-term impact of ACEs

3 Adverse Childhood Experiences ACEs include living in home with: Recurrent physical, emotional, or sexual abuse. An alcohol or drug abuser. An incarcerated household member. Someone who is chronically depressed, suicidal, institutionalized or mentally ill. Mother being treated violently. One or no parents. Emotional or physical neglect.

4 Adverse Childhood Experiences Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States: Smoking, obesity, physical inactivity, depression, suicide attempts, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, history of STDs

5 Negative Coping Mechanisms Smoking Severe obesity Suicide attempts Alcoholism Drug abuse 50+ sex partners ACE Score Repetition of original trauma Self Injury Eating disorders Risk for these Source: Think Trauma Toolkit (NCTSN, 2012)

6 The ACE and Maladaptive Coping Early Death Disease, disability, social problems High Risk Behavior Childhood Adversity Source: Think Trauma Toolkit (NCTSN, 2012)

7 Variability in Responses to Stressors and Traumatic Events The impact of a potentially traumatic event depends on several factors, including: The child s age and developmental stage The child s perception of the danger faced Whether the child was the victim or a witness The child s relationship to the victim or perpetrator The child s past experience with trauma The adversities the child faces following the trauma The presence/availability of adults who can offer help and protection

8 Why Address Toxic Stress? To reduce many of society s most complex and costly medical issues, from heart disease to drug abuse. improve patients health across the lifespan improving the nation s health and economy. Any child who shows risk for toxic stress would receive referrals to specialists for intervention/treatment. Teach parents how best to promote children s social and emotional development to minimize toxic stress.

9 Toxic Stress When toxic stress response occurs continually, or is triggered by multiple sources, it can have a cumulative toll on an individual s physical and mental health for a lifetime. The more adverse experiences in childhood, the greater the likelihood of developmental delays and later health problems, including heart disease, diabetes, substance abuse, and depression. Research also indicates that supportive, responsive relationships with caring adults as early in life as possible can prevent or reverse the damaging effects of toxic stress response.

10 Toxic Stress: The missing link between ACE exposure and poor adult outcomes Identifying children now for adult health later

11 Positive Stress Tolerable Stress Toxic Stress Normal part of health development Brief increase in heart rate and blood pressure Mild elevations in hormone levels Example:Final exam, big game Body s alert system activated to greater degree Activation is timelimited and buffered by caring relationship Brain and organs recover Example:Death of grandparent, car accident Occurs with strong frequent or prolonged adversity No supportive caregiver Disrupts brain architecture and other organ systems Increased risk of stress-related disease and cognitive impairment Example:abuse, neglect, caregiver substance dependence or mental illness National Scientific Council on the Developing Child

12 Examples of Causes of Toxic Stress poverty abuse neglect neighborhood violence substance abuse or mental illness of a caregiver **absence of a supportive caregiver=constant high alert

13 The Impact of Toxic Stress on the Brain At birth, the brain is not fully formed and contains twice as many nerve cells as there will be at age 6. Which cells survive and thrive and which ones do not is determined by a combination of effects involving genes and experiences By age 6, the cells which have survived will form thousands of connections with other cells. Source: Rowe.J. Creating Trauma-Informed CW systems, Chapter 3 p: 33 27

14 Brain Development: Depends on our Experiences Brain development happens from the bottom up: From primitive (basic survival) To more complex (rational thought, planning, abstract thinking) (Continued) 28

15 Brain Development The brain develops by forming connections. Interactions with caregivers are critical to brain development. The more an experience is repeated, the stronger the connections become. 29

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19 Toxic Stress Effects The Brain Amygdala hypertrophy Alarm turned on-not able to take input to quiet alarm Remarkable non-verbal skills (street smarts) Often misinterpret non-verbal cues Hippocampus atrophy Difficulty with learning and memory Frontal Cortex Difficulty with executive functioning Impulse control, working memory and cognitive flexibility

20 Toxic Stress Derails Healthy Development

21 Toxic Stress Can Lead To: Developmental delays Learning disabilities Childhood behavior problems Diabetes Heart disease Depression Drug abuse\ alcoholism

22 Examples of Symptoms After Exposure to Toxic Stress by Age Age Birth to 5 Sleep and/or eating disruptions Withdrawal/lack of responsiveness Intense/pronounced separation anxiety Inconsolable crying Developmental regression, loss of acquired skills Intense anxiety, worries, and/or new fears Increased aggression and/or impulsive behavior Dissociation Age 6-11 Nightmares, sleep disruptions Aggression and difficulty with peer relationships in school Difficulty with concentration and task completion in school Withdrawal and/or emotional numbing School avoidance and/or truancy Age Antisocial behavior School failure Impulsive and/or reckless behavior School truancy Substance abuse Running away Involvement in violent or abusive dating relationships Depression Anxiety Withdrawal

23 The Influence of Developmental Stage: Young Children Young children who have experienced toxic stress may: Express their distress through strong physiological and sensory reactions (e.g., changes in eating, sleeping, activity level, responding to touch and transitions) Become passive, quiet, and easily alarmed Withdrawn, lack of responsiveness, dissociative, numbness Intense anxiety, worry, become fearful, especially regarding separations and new situations Experience confusion about assessing threats and finding protection, especially in cases where a parent or caretaker is the aggressor Engage in regressive behaviors (e.g., baby talk, bed-wetting, crying) Experience strong startle reactions, night terrors, or aggressive/impulsive outbursts Blame themselves due to poor understanding of cause and effect and/or magical thinking

24 Attachment Effects of Toxic Stress Biology Mood regulation Dissociation Behavioral control Cognition Self-concept Development

25 Adverse Childhood Experiences Abuse and Neglect (e.g., psychological, physical, sexual) Household Dysfunction (e.g., domestic violence, substance abuse, mental illness) Impact on Child Development Neurobiological Effects- Toxic Stress (e.g., brain abnormalities, stress hormone dysregulation) Psychosocial Effects (e.g., poor attachment, poor socialization, poor self-efficacy) Health Risk Behaviors (e.g., smoking, obesity, substance abuse, promiscuity) Disease and Disability Major Depression, Suicide, PTSD Drug and Alcohol Abuse Heart Disease Cancer Chronic Lung Disease Sexually Transmitted Diseases Intergenerational transmission of abuse Long-Term Consequences Social Problems Homelessness Prostitution Criminal Behavior Unemployment Parenting problems Family violence High utilization of health and social services Source: Putnam, F.,& Harris, W. (2008). Opportunities to change the outcomes of traumatized children: Draft narrative. Retrieved from

26 Behaviors You Often See: What Toxic Stress Can Look Like (17 month old) The baby is fine Never cries Serious No distress with medical exams Quiet (Kaplow, Dodge, Amaya-Jackson & Saxe, 2005; Shields & Cicchetti, 2001)

27 Behaviors You Often See: What Toxic Stress Can Look Like Anger Hostility and coldness Inability to trust other people Fear Problems with change and transitions Acting guarded and anxious (Kaplow, Dodge, Amaya-Jackson & Saxe, 2005; Shields & Cicchetti, 2001)

28 Behaviors You Often See: What Toxic Stress Can Look Like Difficulty being redirected Physical and emotional reactivity Difficulty calming down after outbursts Difficulty letting go, holding onto grievances Inability to sit still Rejecting support from peers and adults (Kaplow, Dodge, Amaya-Jackson & Saxe, 2005; Shields & Cicchetti, 2001)

29 Getting Development Back on Track Traumatized children and adolescents can learn new ways of thinking, relating, and responding. New experiences with trusted adults and peers can help them to develop alternative views of themselves, the world, and others. Traumatized children can learn new ways of handling overwhelming emotion and new positive coping strategies. Source: Think Trauma Toolkit (NCTSN, 2012)

30 What Can You Do? Educate yourself about children and families you work with Help to communicate physical and psychological safety Help parents to understand their children s behaviors Model and assist children and parents in developing and practicing new coping strategies.

31 Response Office Readiness Colleague support Screening Calm spaces to address Resources and referrals Crisis response resources Positive Relationship Acknowledge, empathy Resist the urge to react Sensitivity to rejection/abandonment Look at all behavior with a toxic stress lens.

32 In Conclusion When the stressors are severe and long-lasting and adult relationships are unresponsive or inconsistent, it s important for families, friends, and communities to intervene with support, services, and programs that address the source of the stress and the lack of stabilizing relationships in order to protect the child from their damaging effects.

33 Questions and Discussion

34 Contact Information Jessica Wozniak, Psy.D., Baystate Children s Hospital, Family Advocacy Center, Clinical Grants Coordinator Telephone:

35 Resources for Today s Training National Child Traumatic Stress Network products Child Welfare Toolkit Think Trauma American Academy of Pediatrics. The Lifelong Effects of Early Childhood Adversity and Toxic Stress.

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